Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
Member of the German Center for Lung Research (DZL), Hannover, Germany.
Eur Respir J. 2022 Jun 2;59(6). doi: 10.1183/13993003.02024-2021. Print 2022 Jun.
Since 2015, the European pulmonary hypertension guidelines recommend the use of combination therapy in most patients with pulmonary arterial hypertension (PAH). However, it is unclear to what extent this treatment strategy is adopted in clinical practice and if it is associated with improved long-term survival.
We analysed data from COMPERA, a large European pulmonary hypertension registry, to assess temporal trends in the use of combination therapy and survival of patients with newly diagnosed PAH between 2010 and 2019. For survival analyses, we looked at annualised data and at cumulated data comparing the periods 2010-2014 and 2015-2019.
A total of 2531 patients were included. The use of early combination therapy (within 3 months after diagnosis) increased from 10.0% in patients diagnosed with PAH in 2010 to 25.0% in patients diagnosed with PAH in 2019. The proportion of patients receiving combination therapy 1 year after diagnosis increased from 27.7% to 46.3%. When comparing the 2010-2014 and 2015-2019 periods, 1-year survival estimates were similar (89.0% (95% CI 87.2-90.9%) and 90.8% (95% CI 89.3-92.4%), respectively), whereas there was a slight but nonsignificant improvement in 3-year survival estimates (67.8% (95% CI 65.0-70.8%) and 70.5% (95% CI 67.8-73.4%), respectively).
The use of combination therapy increased from 2010 to 2019, but most patients still received monotherapy. Survival rates at 1 year after diagnosis did not change over time. Future studies need to determine if the observed trend suggesting improved 3-year survival rates can be confirmed.
自 2015 年以来，欧洲肺动脉高压指南建议大多数肺动脉高压（PAH）患者采用联合治疗。然而，目前尚不清楚这种治疗策略在临床实践中采用的程度，以及它是否与长期生存的改善有关。
我们分析了来自 COMPERA 的数据，这是一个大型的欧洲肺动脉高压登记处，以评估 2010 年至 2019 年间新诊断的 PAH 患者联合治疗的使用情况和生存情况的时间趋势。对于生存分析，我们查看了年度数据和累积数据，比较了 2010-2014 年和 2015-2019 年两个时期。
共纳入 2531 例患者。早期联合治疗（诊断后 3 个月内）的使用率从 2010 年诊断为 PAH 的患者的 10.0%增加到 2019 年诊断为 PAH 的患者的 25.0%。诊断后 1 年接受联合治疗的患者比例从 27.7%增加到 46.3%。比较 2010-2014 年和 2015-2019 年两个时期，1 年生存率估计值相似（分别为 89.0%（95%CI 87.2-90.9%）和 90.8%（95%CI 89.3-92.4%）），而 3 年生存率估计值略有但无统计学意义的改善（分别为 67.8%（95%CI 65.0-70.8%）和 70.5%（95%CI 67.8-73.4%））。
从 2010 年到 2019 年，联合治疗的使用有所增加，但大多数患者仍接受单药治疗。诊断后 1 年的生存率没有随时间变化。未来的研究需要确定观察到的 3 年生存率改善趋势是否可以得到证实。
